Biological Therapies

Question 1

How can anti-psychotics be taken?

Answer 1

Can be taken as a tablet or in syrup form. For some who are at risk if they don’t take their meds, may be given injections every 2-4 week
They may be required in the short or long term, some may take a short course then stop their use without the return of symptoms, others require the drugs for life

Question 2

What can anti-psychotics be divided into?

Answer 2

Typical, the newer atypical or second-generation drugs

Question 3

What are typical antipsychotics and their dosage?

Answer 3

Around since 1950’s, including Chlorpromazine, can be taken as tablets, syrups or injections
If taken orally, administered daily up to 1000mg, although initially doses are smaller and increases e.g. 400 to 800mg
typically doses have declined over last 50 years

Question 4

What has there been a strong association between?

Answer 4

The use of chlorpromazine and the dopamine hypothesis. They work as antagonists in the dopamine system which are chemicals which reduce the action of a neurotransmitter

Question 5

How do dopamine antagonists work (typical)?

Answer 5

By blocking dopamine receptors in the synapse of the brain, reducing the action of dopamine
Initially dopamine production is increases when patients start to take the med, then it’s reduced
It normalises neurotransmission in key areas of the brain reducing symptoms like hallucinations

Question 6

What is chlorpromazine often used to do?

Answer 6

Calm patients with Sz and other conditions
This is often done when persons enter hospitals for the first time
Syrup works faster and has sedative properties

Question 7

What are atypical antipsychotics?

Answer 7

Clozapine - was developed in the 60’s and trialled in the 70’s, following the deaths of patients from the blood condition angranulocytosis it was withdrawn
However in the 80’s when it was discovered to be more effective than other drugs it was remarketed as a treatment to be used when other treatments had failed

Question 8

Why can Clozapine not be injected?

Answer 8

It has deadly side-effects so the typical dosage is 300-450mg

Question 9

How does clozapine work?

Answer 9

It binds to dopamine but also acts on serotonin and glutamate receptors - this action improves mood and reduced depression and anxiety in patients and may improve cognitive functioning - this mood enhancing effect means that it is prescribed to suicidal patients which is significant as 30-50% of patients do attempt suicide.

Question 10

What is Risperidone and how is it administered?

Answer 10

Developed as a safer alternative to clozapine, can be taken as a tablet, syrup or injection that lasts 2 weeks
A small dosage administered initially (typically between 4 and 8 mg with max of 12)

Question 11

What is good about risperidone?

Answer 11

It binds more strongly to dopamine receptors and is therefore effective in a much smaller dose
There is evidence that this may lead to fewer side effects

Question 12

Who conducted research into the effectiveness of Chlorpromazine and what was it?

Answer 12

Thornley et al reviewed studies comparing the effects of Chlorpromazine to control conditions in which patients received a placebo so their experiences were identical except for the presence of Chlorpromazine in their medication
Date from 13 trials with 1121 participants demonstrated that CH was associated with better overall functioning and reduced symptom severity
Data from 3 trials with 512 participants showed that the replase rate was reduced when CH was taken

Question 13

What was Meltzers research into the effectiveness of Clozapine?

Answer 13

He concluded that it was more effective than typical antipsychotics and other atypical anti-psychotics including 30-50% treatment resistant cases where typical antipsychotics have failed.
Other studies have compared Clozapine with Risperidone but results have been inconclusive, it may be that patients react differently to different drugs

Question 14

What are the usual side-effects of typical antipsychotics?

Answer 14

Dizziness, sleepiness, stiff jaw, weight gain and itch skin
Long term = Tardive dyskibesia which is caused by dopamine super-sensitivity and manifests itself in grimacing, blinking and lip smacking
Neuroleptic malignant syndrome is believed to cause the dopamine blocking action in the hypothalamus can results in high temp, delirium and can be fatal (as typical doses of drugs have reduced, this has become a rarer condition 0.1-2%

Question 15

What have atypical antipsychotics done to side effects?

Answer 15

Reduced the frequency of them

Clozapine patients have to have regular blood tests

Question 16

How does the use of antipsychotics depend on the dopamine hypothesis?

Answer 16

The hypothesis suggests that there are higher levels of dopamine activity in the subcortex, however there is evidence that the original dopamine hypothesis was incomplete and that in other parts of the brain dopamine levels are too low rather than too high and therefore its unclear how dopamine antagonists can help reduce activity - our recent understanding suggests that antipsychotics shouldn’t work

Question 17

What are the problems with the evidence for effectiveness?

Answer 17

Healy has suggested that some successful trials have had their data published numerous times, exaggerating the evidence of positive effects
Positive effects are not the same as reducing the severity of the psychosis
Studies address short term rather than long-term benefits and compare patients who continue to take medication with those suffering from withdrawal from just stopping taking theirs

Question 18

What is the chemical cosh argument?

Answer 18

It is widely believed that antipsychotics have been used in hospital situations to calm patients and make them easier for staff to work with rather than for the benefit of the patient
Although short-term use of the drug is recommended by NICE, this is viewed by some as a human rights abuse